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Purpose Inguinal lymph nodes are a rare but recognised site of metastasis in rectal adenocarcinoma. No guideline or consensus exists for the management of such cases. This review aims to provide a contemporary and comprehensive analysis of the published literature to aid clinical decision-making. Methods Systematic searches were performed using the PubMed, Embase, MEDLINE and Scopus and Cochrane CENTRAL Library databases from inception till December 2022. All studies reporting on the presentation, prognosis or management of patients with inguinal lymph node metastases (ILNM) were included. Pooled proportion meta-analyses were completed when possible and descriptive synthesis was utilised for the remaining outcomes. The Joanna Briggs Institute tool for case series was used to assess the risk of bias. Results Nineteen studies were eligible for inclusion, encompassing 18 case series and one population-based study using national registry data. A total of 487 patients were included in the primary studies. The prevalence of ILNM in rectal cancer is 0.36%. ILNM are associated with very low rectal tumours with a mean distance from the anal verge of 1.1 cm (95% CI 0.92–1.27). Invasion of the dentate line was found in 76% of cases (95% CI 59–93). In patients with isolated inguinal lymph node metastases, modern chemoradiotherapy regimens in combination with surgical excision of inguinal nodes are associated with 5-year overall survival rates of 53–78%. Conclusion In specific subsets of patients with ILNM, curative-intent treatment regimens are feasible, with oncological outcomes akin to those demonstrated in locally advanced rectal cancers.

This study aims to understand the factors affecting the switching behaviour of young consumers in the cellular service industry of Pakistan. The present study has identified the significant (price and social influence) and insignificant (network coverage and promotion) factors that provoke consumers to switch their cellular service provider. This research used a quantitative research design, and data were collected using the questionnaire technique. Through random sampling, undergraduate students of private universities of engineering, computer science, and management sciences departments in Karachi, Pakistan, were selected and administered 270 questionnaires. However, 184 respondents provided their useful feedback with a response rate of 68%. The present study has identified that price and social factors play a significant role in influencing consumers switching behaviour. In contrast, promotion and network coverage do not impact young adults switching behaviour in the cellular service sector of Pakistan. Since the research has targeted the telecom industry of Pakistan, it contributes to the literature on marketing and consumer behaviour by identifying and comprehending the theoretical framework and dimensions associated with consumer switching behaviour.

Background: The constituents of Lavandula stoechas L. possess antioxidant properties that help in protecting the mucosal cells from oxidative damage and speed up the healing process however, its role in the treatment of ethanol-induced peptic ulcers is not clear. Objectives: We aimed to evaluate the pharmacological potential of Lavandula stoechas L. extracts for anti-ulcer activity, and compare with the standard drugs and to explore novel treatment for peptic ulcer. Methods: We evaluated anti-ulcer potential of plant extract in ethanol-induced ulcer model in rats. Omeprazole and ranitidine were standard drugs. After 5 h of disease induction, animals were sacrificed to get tissues for histological evaluation and ulcer index was measured. While the antimicrobial potential of Lavandula stoechas L. aqueous and methanolic extracts was evaluated against different bacterial stains using standard antibiotic discs. Qualitative phytochemical and GCMS analysis were performed to identify novel constituents. Results: The methanolic extract of Lavandula stoechas L. showed antimicrobial activity against Proteus Mirabilis while the GCMS based analysis revealed the presence of 10 phytochemicals including camphor (antimicrobial agent). The aqueous extract showed significant anti-ulcer activity in ethanol-induced gastric (P < 0.001) and duodenal (P < 0.01) ulcers when compared with controls. Aqueous and methanolic Lavandula stoechas L. extracts showed strong free radical scavenging activity. Conclusion: Lavandula stoechas L. extract possess antimicrobial and anti-ulcer activity in alcohol-induced ulcer model in experimental animals.

There has been an increase in the utilization of robotic surgery in addition to traditional open or laparoscopic approaches. Aim of this study is to compare the short-term outcomes for open, laparoscopic, and robotic surgery for rectal and sigmoid cancer. One hundred and forty-seven patients (open n = 48, laparoscopic n = 49, robotic n = 50) undergoing curative resections by two surgeons between 2013 and 2020 were included. Data analyzed included patient demographics, tumor characteristics, length of stay, post-operative outcomes, and pathologic surrogates of oncologic results, including total mesorectal excision (TME) quality, circumferential resection margin (CRM) involvement and lymph node (LN) yield. Median age of population was 68 years (IQR 59-73), majority (68%) were males. Median distance from anal verge in the robotic surgery group was 8 cm, compared to 15 and 14.5 cm in the open and laparoscopic groups, respectively, p = 0.029, (laparoscopic vs robotic, p = 0.005 and open vs robotic, p = 0.027). Proportion of patients who received neoadjuvant radiotherapy in robotic surgery group was higher, p = 0.04. In sub-group of tumors between 3 and 7 cm from anal verge more patients in the robotic surgery group had sphincter preservation, p = 0.006. Length of stay, maximum C-reactive protein, and white blood cell rise favored minimally invasive approaches compared to open surgery. There were no differences in post-operative complications, lymph node yield or CRM positivity rate between the three groups. Robotic surgery approach is safe and allows sphincter preservation without compromising TME quality in rectal cancer surgery.